59
Acute lesions of patients with AMI may have more thrombotic
burden and less fibrous atheroma and may be less prone
to restenosis compared with stable plaques of those with
stable angina [31]. Therefore, the impact of TAP may not
be prominent in restenosis or TLR rates between DTAP in
patients with AMI. However, a large-scale prospective ran-
domized trial is needed to assess the reduction of restenosis
according to DTAP.
[4] Stone GW, Lansky AJ, Pocock SJ, Gersh BJ, Dangas G, Wong SC,
Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek
D, Mockel M, Ochala A, Kellock A, Parise H, et al. Paclitaxel-
eluting stents versus bare-metal stents in acute myocardial
infarction. N Engl J Med 2009;360:1946—59.
[5] Valgimigli M, Campo G, Percoco G, Bolognese L, Vassanelli C,
Colangelo S, de Cesare N, Rodriguez AE, Ferrario M, Moreno R,
Piva T, Sheiban I, Pasquetto G, Prati F, Nazzaro MS, et al. Com-
parison of angioplasty with infusion of tirofiban or abciximab
and with implantation of sirolimus-eluting or uncoated stents
for acute myocardial infarction: the MULTISTRATEGY random-
ized trial. JAMA 2008;299:1788—99.
Study limitations
[6] Lee SR, Jeong MH, Ahn YK, Chae SC, Hur SH, Kim YJ, Seong IW,
Chae JK, Hong TJ, Rhew JY, Cho MC, Bae JH, Rha SW, Kim CJ,
Jang YS, et al. Clinical safety of drug-eluting stents in the Korea
acute myocardial infarction registry. Circ J 2008;72:392—8.
[7] Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger
C, Kukreja N, Juni P, Sianos G, Hellige G, van Domburg RT, Hess
OM, Boersma E, Meier B, Windecker S, et al. Early and late
coronary stent thrombosis of sirolimus-eluting and paclitaxel-
eluting stents in routine clinical practice: data from a large
two-institutional cohort study. Lancet 2007;369:667—78.
[8] Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong
MK, Kim JJ, Park SJ. Frequency of and risk factors for stent
thrombosis after drug-eluting stent implantation during long-
term follow-up. Am J Cardiol 2006;98:352—6.
[9] Chen KY, Rha SW, Li YJ, Poddar KL, Jin Z, Minami Y, Wang L,
Kim EJ, Park CG, Seo HS, Oh DJ, Jeong MH, Ahn YK, Hong TJ,
Kim YJ, et al. Triple versus dual antiplatelet therapy in patients
with acute ST-segment elevation myocardial infarction under-
going primary percutaneous coronary intervention. Circulation
2009;119:3207—14.
The main limitation of our study is that it was conducted as
a single-center, retrospective non-randomized comparative
one. This might have introduced a significant bias in patient
selection, even though it was partially compensated for by
multivariate Cox regression model using propensity score to
control the baseline biases. It was another limitation that
there were few medical records about adverse reactions to
cilostazol and why the patients stopped taking cilostazol.
Also, each patient was very different in DTAP. Accordingly,
we were unable to define the exact optimal DTAP. It is the
other limitation that a regular follow-up coronary angiog-
raphy within 12 months was performed for approximately
53.9% of the patients. Most of TLRs were performed based
on the judgment of operators on a regular follow-up coro-
nary angiography rather than the ischemic symptoms. Owing
to this, the possibility for selection bias could not be com-
pletely ruled out.
[10] Han Y, Li Y, Wang S, Jing Q, Wang Z, Wang D, Shu Q, Tang
X. Cilostazol in addition to aspirin and clopidogrel improves
long-term outcomes after percutaneous coronary intervention
in patients with acute coronary syndromes: a randomized, con-
trolled study. Am Heart J 2009;157:733—9.
Conclusion
Our data show that DTAP ≥3 months is associated with bet-
ter clinical outcomes than that of <3 months in patients
with AMI undergoing DES implantation without increasing
bleeding complications. However, large-scale, long-term,
prospective, randomized trials are needed to assess the
exact optimal DTAP in AMI patients.
[11] Park KH, Jeong MH, Lee MG, Ko JS, Lee SE, Kang WY, Kim SH,
Sim DS, Yoon NS, Youn HJ, Hong YJ, Park HW, Kim JH, Ahn Y,
Cho JG, et al. Efficacy of triple anti-platelet therapy including
cilostazol in acute myocardial infarction patients undergoing
drug-eluting stent implantation. Korean Circ J 2009;39:190—7.
[12] King 3rd SB, Smith Jr SC, Hirshfeld Jr JW, Jacobs AK, Morri-
son DA, Williams DO, Feldman TE, Kern MJ, O’Neill WW, Schaff
HV, Whitlow PL, Adams CD, Anderson JL, Buller CE, Creager
MA, et al. 2007 Focused Update of the ACC/AHA/SCAI 2005
Guideline Update for Percutaneous Coronary Intervention: a
report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines: 2007 Writing
Group to Review New Evidence and Update the ACC/AHA/SCAI
2005 Guideline Update for Percutaneous Coronary Interven-
tion, Writing on the 2005 Writing Committee. Circulation
2008;117:261—95.
Acknowledgment
This research was supported by the Pioneer Research Center
Program through the National Research Foundation of Korea
funded by the Ministry of Education, Science and Technology
(2010 0002170).
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